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D8t@? /� PuElic Worhs Perm�t• <br /> eioc.oeci.. l.3(aS3 <br /> Appiitalion For <br /> PUBL,IC WORKS P�RMIT PubToteFeeFae S <br /> L06e AUp� Fen PaiC S <br /> Belmce Due S <br /> Print or Type Only <br /> �ff2n7"� ��cP �F+rcarJ \I3Sn1 ���% - c�7/d <br /> Owner Mailing Address City Zip Phone <br /> �jqME� ._I� ICK _.L�✓UPJ'� <br /> Applicant T Maili g Address Cdy Zip Phone <br /> Describe Proposed Work I' ` �""�^"x^ " -"' � � " '�T"'� � <br /> v <br /> W <br /> Pro�ect Address(il known) �� � � ~ <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note tha following as applicable: � <br /> • Properry Lines • Centeiline of street ♦A <br /> • Outline and dimensions oi all existing and • Indicate Norih V� <br /> proposed structures on Ihe lot • Show any proposed grading chanqes <br /> • Existing and proposed utililies • Show measurements M <br /> W <br /> DO NO�WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7, All calls lor inspection shall�e made 24 hrs. in adva�ce- phone 259•881 5. ^ <br /> 2. All work shall be per(ormed in accordance with this permit and current City of Everett Design and Construclion ♦ <br /> Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs belore you dig.TOLL FREE NUMBER 1-800•424•5555. � � <br /> r <br /> / � � <br /> s � � � <br /> � �� c- �; �/� � � � � � <br /> � - � ~ � <br /> �V � <br /> 0 <br /> �, n �� �� � , a � � <br /> � � � � � F. <br /> � � . � , <br /> ACKNOWLEDGEMENT OF CONDITIONS �> ' <br /> The undersigned owner/applicant hereby agrees to hold and save ham. r�� i. <br /> less the City ol Everet� from any and all claims for damages, costs, '-= � <br /> expenses, or causes ol action thal may arise because ol mstallation �-? , <br /> and maintenance ol the improvement or other righl�of�way use hereto ry ; <br /> applied tor and further agrees to remove same upon notice irom Ihe <br /> Approved for Construction Date City and to replace puClic property damaqed thereby. <br /> i; <br /> FINAL INSPECTION Dale � ��� <br /> Approved as ConstruCted Signature ol Applicant Date a i <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> everett 180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO � !� <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COM1IPL[710N. THIS PFf3'.?IT `:1�Y BE ' <br /> Eve�ett,WA 98201 CANCELLED BV THE CITV UPON ANY STOPPAGE' i)F tVOR�:�)N 71 uti <br /> Phonc: 259-8615 PROJECT OVER 50 DAYS DURATION. <br />